Summary of interventions to increase referral to and uptake of Pulmonary Rehabilitation (PR) programmes for people with Chronic Obstructive Pulmonary Disease (COPD)
| Authors, Date, Setting | Design | Participants | Intervention | Outcomes | Results/Effect |
|---|---|---|---|---|---|
| Angus et al., 2012, UK | Observational/feasibility study covering several aspects of COPD management | 293 patients | Computer-guided review by practice nurse | % referred to PR | 24% of patients referred |
| Foster et al., 2016, UK | Participatory action research with strategies for increasing referrals for PR | 22 clinicians 126 patients | Included in-house education sessions, changes to practice protocols, and ‘pop-ups’ and memory aids (mugs and coasters) to prompt clinician/patient discussions about PR. | Patient survey | Survey reports expectation of increased access to benefits of PR |
| Graves et al., 2010, UK | Before/After comparison | 600 patients (200 control/400 intervention) | Group opt-in session prior to individualised assessment and entry to PR | % taking up baseline assessment,% attending and completion of PR | No effect on initial uptake |
| Harris et al., 2009, Australia | Controlled Before/After study | 249 patients | Patient-held manual of recommended COPD management | % enrolment to PR, other indicators of COPD management | Increased enrolment in PR seen only in most socioeconomically disadvantaged participants (outcome change + 12%) |
| Hull et al., 2014, UK | Quality improvement with repeated audit cycles | 3391 patients on COPD registers across network | Establishment of networks of GP practices with supported case management, education and financial incentives for clinical performance | % PR referrals, other indicators of COPD management | PR referrals rose 25% from 45% to 70% |
| Roberts et al., 2015, UK | Pragmatic non-randomised controlled study | 1235 patients (640 intervention/595 control) | Patients provided with individualised COPD care quality “score cards” | % PR referrals | 6.1% increase in referrals in intervention group |
| Zwar et al., 2012, Australia | Cluster randomised controlled trial with blinded outcome assessment | 451 patients (257 (57.8%) confirmed to have COPD) | Home visit by nurse with specific COPD training working with GP to implement individualised care plan based on guidelines | % attendance at PR, other indicators of COPD management | 21.5% increase in PR attendance (31.1% v 9.6%; OR, 5.16; 95% CI: 2.40–11.10) |